Anonymous note left by a survivor of suicide loss at the
American Foundation for Suicide Prevention's
2017 Out of the Darkness Walk, in San Francisco.
If someone you know is showing one or more of the following behaviors, he or she may be thinking about suicide. Don’t ignore these warning signs. Reach out to the person, it is ok to ask them directly if they are feeling suicidal.
- Talking about wanting to die or to kill oneself
- Looking for a way to kill oneself / seeking the means
- Talking about feeling hopeless or having no reason to live
- Getting affairs in order
- Making an effort to say goodbye
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others / expressions of self loathing
- Increasing the use of alcohol or drugs
- Acting anxious or agitated; behaving recklessly
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
It is important to note that suicide is not always preceded by warning signs. Many friends and family members question why they were unable to see the signs, and they feel guilty for not having known ahead of time that their loved one was feeling suicidal. However, at present without better professional risk assessment and intervention methods, it can be difficult for lay people to identify suicidal ideation in others.
Chester Bennington, lead singer of the band Linkin Park, committed suicide on July 20, 2017. His wife Talinda shared this photo of him, which was taken just days before his death. In the photo, Bennington is smiling, laughing, and comes across and healthy and happy.
In the Harvard Medical School Health Blog, Dr. Michael Miller, (assistant professor of psychiatry) notes:
"Many people never let on what they are feeling or planning. The paradox is that the people who are most intent on committing suicide know that they have to keep their plans to themselves if they are to carry out the act, thus, the people most in need of help may be the toughest to save.”
We must fund research into better identification tools and resources so that we can educate the public about how to identify suicide risk factors, and so that we can offer interventions that show efficacy in addressing suicide.
Lack of understanding is widespread and systemic and it impacts both public information and the behavioral health systems in this country.
As of September 2017, most organizations with expertise in suicide prevention agree that the present resources we have for professional screening and assessment are inadequate. Too many people are slipping through the cracks and risk is either missed or dismissed by professionals.
The American Psychiatric Association Work Group on Suicidal Behaviors (2003) concluded that “although suicide assessment scales have been developed for research purposes, they lack the predictive validity necessary for use in routine clinical practice. Therefore, suicide assessment scales may be used as aids to suicide assessment but should not be used as predictive instruments or as substitutes for a thorough clinical evaluation.”
The American Academy of Pediatrics Committee on Adolescence (2007) reported that “no specific tests are capable of identifying a suicidal person” and “scales…tend to be oversensitive and underspecific and lack predictive value.”
The Department of Veterans Affairs/Department of Defense Assessment of Risk for Suicide Working Group (2013) concluded that “suicide risk assessment remains an imperfect science, and much of what constitutes best practice is a product of expert opinion, with a limited evidence base.”
We must fund more research in evidence based approaches to suicide screening and assessment. We must have adequate tools to recognize a patient's risk, when they are present in a clinical setting.
We must require all health care providers and insurance companies to understand how screening and assessments work, when to implement them, and what services to provide when risk is identified.
Ending the stigma associated with suicide and mental illness, and advocating for research, prevention, and treatment services, is the key to better treatment outcomes.
This needs to happen now.
References:
Clinical information on suicide screening and assessment from the Suicide Prevention and Resource Center:
Clinical information on suicide screening and assessment from the Suicide Prevention and Resource Center:
